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WO2015032676A1 - Système de navigation - Google Patents

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Publication number
WO2015032676A1
WO2015032676A1 PCT/EP2014/068219 EP2014068219W WO2015032676A1 WO 2015032676 A1 WO2015032676 A1 WO 2015032676A1 EP 2014068219 W EP2014068219 W EP 2014068219W WO 2015032676 A1 WO2015032676 A1 WO 2015032676A1
Authority
WO
WIPO (PCT)
Prior art keywords
shape
interventional
during
stored
navigation
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/EP2014/068219
Other languages
English (en)
Inventor
Michael Grass
Neriman Nicoletta Kahya
Sven Prevrhal
Marco VERSTEGE
Eberhard Sebastian Hansis
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Koninklijke Philips NV
Original Assignee
Koninklijke Philips NV
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Koninklijke Philips NV filed Critical Koninklijke Philips NV
Priority to JP2016539475A priority Critical patent/JP6480938B2/ja
Priority to EP14755831.6A priority patent/EP3041409A1/fr
Priority to US14/914,016 priority patent/US11395702B2/en
Priority to CN201480048813.6A priority patent/CN105517489B/zh
Publication of WO2015032676A1 publication Critical patent/WO2015032676A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; Determining position of diagnostic devices within or on the body of the patient
    • A61B5/065—Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
    • A61B5/066—Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2051—Electromagnetic tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2061—Tracking techniques using shape-sensors, e.g. fiber shape sensors with Bragg gratings
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy

Definitions

  • the invention relates to a navigation system, a navigation method and a navigation computer program for navigating an interventional device like a catheter or a guidewire to a target region within a living being.
  • the invention further relates to an interventional system comprising the navigation system.
  • a transarterial chemoembolization (TACE) intervention generally comprises several interventional sessions, wherein in each of these interventional sessions a catheter is navigated to a part of the hepatic artery providing a tumor with blood, wherein
  • chemoembolization material is injected at the location to which the catheter has been navigated.
  • the navigation of the catheter to the part of the hepatic artery providing the tumor with blood is generally relatively inaccurate such that it is difficult to ensure that in different interventional sessions the catheter is navigated along the same path to the same location. This can decrease the quality of the intervention.
  • a navigation system for navigating an interventional device to a target region within a living being comprising:
  • a position and shape determining unit for determining and storing a first position and shape of an interventional device within the living being during a first interventional procedure, wherein the position and shape determining unit is further adapted to determine a second position and shape of an interventional device within the living being during a subsequent second interventional procedure, and
  • a navigation device for navigating the interventional device during the second interventional procedure based on the stored first position and shape and based on the second position and shape.
  • the navigation device is adapted for navigating the interventional device during the second interventional procedure based on the stored first position and shape, which has been determined during the first interventional procedure, and based on the second position and shape, which has been determined during the second interventional procedure, the path within the living being used during the first interventional procedure and the actual path of the interventional device determined during the second interventional procedure can both be considered, while navigating the interventional device during the second
  • the navigation of the interventional device during the second interventional procedure can be corrected such that the position and shape of the interventional device during the second interventional procedure is similar to the position and shape of the interventional device during the first interventional procedure, in order to ensure that during the first interventional procedure and during the second interventional procedure the interventional device is navigated along the same path within the living being.
  • This allows for an improvement of an intervention like a chemoembolization intervention comprising different interventional procedures, which may also be regarded as being different interventional sessions. This can further allow for a reduced time needed for the entire intervention, because the same path can be found in different interventional sessions faster.
  • the first interventional procedure and the second interventional procedure are part of an overall intervention.
  • This overall intervention may span a number of days, with a relatively long period between the first interventional procedure and the second
  • the overall intervention can also be performed in a shorter period with relatively short time or practically no time between the first interventional procedure and the second interventional procedure.
  • the overall intervention is essential a single, complex procedure and the first and second interventional procedures are interventional sessions of this complex procedure and the patient will be treated during this complex procedure substantially without interruption.
  • Examples of such complex procedures are the procedures for placement of a stent like in EndoVascular Aortic Repair (EVAR) or Fenestrated Endo vascular Aortic Repair (FEVAR) to treat aneurysms.
  • EVAR EndoVascular Aortic Repair
  • FEVAR Fenestrated Endo vascular Aortic Repair
  • the determined positions and shapes are preferentially three-dimensional positions and shapes describing three-dimensional paths, along which the interventional device is navigated during the first and second interventional procedures.
  • the overall intervention can have more than two interventional procedures, wherein in all or in at least some of these interventional procedures the respective position and shape of the
  • interventional device is determined, wherein the navigation device is adapted for navigating the interventional device during a current interventional procedure based on the position and shape determined during the current interventional procedure and on at least one stored position and shape determined during a previous interventional procedure for navigating the interventional device during the different interventional procedures along the same path.
  • the interventional device may be a vascular interventional device like a catheter, a guidewire, et cetera.
  • the interventional procedures are preferentially percutaneous interventional procedures; in particular, they are preferentially parts of a TACE intervention.
  • the navigation device can be adapted for navigating the interventional device based on the entire respective position and shape or based on a part of the respective position and shape. For instance, the navigation device can be adapted for navigating the
  • interventional device based on a part of the stored first position and shape and on the entire second position and shape.
  • the position and shape determining unit is adapted to determine the first and second positions and shapes by optical shape sensing. Determining the first and second positions and shapes by optical shape sensing allows determining these positions and shapes very accurately in a way, which is very simple for the user, i.e. the user does not need to handle different devices in a complicated way for determining the positions and shapes in the different interventional procedures.
  • the navigation device preferentially comprises a display for displaying the stored first position and shape and the second position and shape and a user interaction unit for allowing a user to move the interventional device during the second interventional procedure based on the displayed first and second positions and shapes.
  • the navigation system may further comprise an imaging device for generating an image of the living being at least during the second interventional procedure, wherein the display may be adapted to show an overlay image showing the stored first position and shape and the second position and shape overlaid on the image.
  • the imaging device is preferentially adapted to provide an x-ray projection image of the living being such that the stored first position and shape and the second position and shape can be shown on the x-ray projection image.
  • a user can reliably navigate the interventional device during the second interventional procedure along a path being equal to the path along which the interventional device has been navigated during the first interventional procedure by observing the first and second positions and shapes of the interventional devices on the x-ray projection image.
  • the navigation device is adapted to compare the stored first position and shape with the second position and shape and to navigate the interventional device during the second interventional procedure based on the comparison.
  • the navigation device can be adapted to automatically navigate the interventional device during the second interventional procedure such that the actual second position and shape is similar to at least a part of the first position and shape based on a comparison of the first and second positions and shapes.
  • the position and shape determining unit is adapted to continuously determine the second position and shape during the second interventional procedure, wherein the navigation device is adapted for navigating the interventional device during the second interventional procedure depending on the stored first position and shape and the actual second position and shape.
  • the second position and shape can be continuously determined in the second interventional procedure such that an overlay image can show the actual second position and shape together with the previously determined stored first position and shape on an x-ray projection image, which has been acquired in the second interventional procedure and which may be an actual image of the living being, in order to allow a user to navigate the interventional device during the second interventional procedure based on the live overlay image.
  • the position and shape determining unit is adapted to determine and store the first position and shape of the interventional device, when the interventional device has reached the target region during the first interventional procedure.
  • the entire length of the path which is defined by the position and shape of the interventional device during the first interventional procedure, when the interventional device has reached the target region, can be stored and used for navigating the interventional device during the second interventional procedure, in order to navigate the interventional device during the second interventional procedure along the entire path used during the first interventional procedure.
  • the position and shape determining unit can be adapted to determine and store several first positions and shapes of the interventional device, while the interventional device is moved during the first interventional procedure, wherein at least one first position and shape is determined and stored, before the interventional device has reached the target region.
  • the position and shape determining unit can be adapted to determine and store a first position and shape, when the interventional device has reached the target region in the first interventional procedure, and at least one further first position and shape, before the interventional device has reached the target region in the first interventional procedure.
  • a first position and shape can be determined and stored, before the interventional device has reached the target region in the first interventional procedure, when it has reached a critical location within the living being like a vascular branch point.
  • the navigation system may comprise a user interface allowing a user to indicate when the first position and shape should be stored, wherein the position and shape determining unit can be adapted to store the first position and shape, when the user has indicated that the first position and shape should be stored.
  • the user can indicate that the first position and shape should be stored at several times during the first interventional procedure, in order to store several first positions and shapes of the interventional device during the first interventional procedure. For instance, the user may prompt the navigation system to store a first position and shape during the first interventional procedure, when the interventional device has reached a critical location within the living being like a vascular branch point.
  • the navigation device may also comprise a user interface allowing a user to indicate a part of the stored first position and shape, wherein the navigation device can be adapted for navigating the interventional device during the second interventional procedure based on the indicated part of the stored first position and shape and the second position and shape.
  • the navigation device may comprise a display for displaying the stored first position and shape, wherein the user interface may be adapted to allow the user to mark on the displayed stored first position and shape a part of the first position and shape for indicating the same.
  • the user may mark the point on the original path, i.e. on the stored first position and shape of the interventional device, up to which the user wants to follow the first position and shape.
  • the stored first position and shape may be marked starting from the aorta, i.e. the path of the interventional device
  • the position and shape determining unit is adapted to a) register the stored first position and shape and the second position and shape to each other such that a similarity measure, which is indicative of a degree of similarity between the stored first position and shape and the second position and shape, is maximized, and b) determine whether during the first and second interventional procedures the navigation is performed along the same path based on the maximized similarity measure. For instance, if the maximized similarity measure is smaller than a predefined threshold, it can be determined that the navigation is performed along different paths during the first and second
  • the similarity measure can be based on, for instance, the
  • the navigation system further comprises an inner structure providing unit for providing an inner structure of the living being, wherein the navigation device comprises a display for displaying the inner structure together with the stored first position and shape and the second position and shape.
  • the system can be adapted such that the part of the inner structure from an entry location of the interventional device, at which the interventional device has entered the living being in the second interventional procedure, to a location of a tip of the interventional device as indicated by the second position and shape of the interventional device is displayed.
  • the inner structure may be provided by providing a roadmap of the vascular system within the living being.
  • the display may then be adapted to display the part of the roadmap from the entry location of the interventional device, at which the interventional device has entered the vascular system of the living being in the second interventional procedure, to the location of the tip of the interventional device as indicated by the second position and shape of the interventional device, in order to display the part of the roadmap, which is currently relevant for navigating the interventional device during the second interventional procedure.
  • the system may be adapted to only display the part of the inner structure from the entry location of the interventional device, at which the interventional device has entered the living being in the second interventional procedure, to the location of the tip of the interventional device as indicated by the second position and shape of the interventional device on the display and to not show additionally the remaining part of the inner structure.
  • the system can also be adapted to show the entire inner structure and to display the part of the inner structure from the entry location of the interventional device to the location of the tip of the
  • interventional device as indicated by the second position and shape of the interventional device by highlighting this part with respect to the remaining part of the inner structure.
  • the part to be displayed can be shown with a higher intensity or with a color which is different to a color of the remaining part of the inner structure.
  • the position and shape determining unit may be adapted to determine and store in the first interventional procedure the position and shape of a first interventional device as the stored first position and shape and to determine in the second interventional procedure the position and shape of a second interventional device as the second position and shape, wherein the navigation device may be adapted for navigating the second interventional device during the second interventional procedure based on the stored first position and shape and the second position and shape.
  • different interventional devices may be used.
  • the same interventional device may be used in the first and second interventional procedures.
  • an interventional system for applying an interventional procedure to a living being comprising:
  • an interventional device for performing the interventional procedure, and - a navigation system for navigating the interventional device to a target region within the living being as defined in claim 1.
  • a navigation method for navigating an interventional device to a target region within a living being comprising:
  • a navigation computer program for navigating an interventional device to a target region within a living being is presented, wherein the navigation computer program comprises program code means for causing a navigation system as defined in claim 1 to carry out the steps of the navigation method as defined in claim 14, when the navigation computer program is run on a computer controlling the navigation system.
  • Fig. 1 shows schematically and exemplarily an interventional system for applying an interventional procedure to a living being
  • Fig. 2 shows schematically and exemplarily an inner structure of the living being together with positions and shapes of a catheter determined in different interventional procedures
  • Fig. 3 shows a flowchart exemplarily illustrating an embodiment of an interventional method for applying an interventional procedure to a living being.
  • Fig. 1 shows schematically and exemplarily an embodiment of an interventional system for applying an interventional procedure to a living being.
  • the interventional system 1 is adapted to perform a TACE intervention.
  • the interventional system 1 comprises a catheter 11 for being navigated to the hepatic artery of a person 9 lying on a support means like a table 8.
  • the catheter 11 is preferentially navigated from the right groin through the femoral artery, the abdominal aorta and the celiac trunk to the common hepatic artery.
  • the catheter 11 is preferentially adapted to be navigated via a user interaction unit 12 by a user like a physician.
  • the catheter 11 can comprise several portions, which are connected by hinges such that the portions are pivotable with respect to each other by using wires connected to the respective portions.
  • one end of a respective wire can be connected to a respective portion of the catheter 11 and the other end of the respective wire can be connected to a respective motor of the user interaction unit 12 such that the different portions of the catheter 11 can be pivoted with respect to each other via the wires and the motors in the user interaction unit 12.
  • the user interaction unit 12 can comprise at least two further motors for translating the entire catheter 11 and for rotating the entire catheter 11.
  • the user interaction unit 12 may comprise a mechanical fixture for clamping the catheter 11 , wherein the at least two further motors may be adapted to translate the mechanical fixture along a rail and to rotate the mechanical fixture.
  • the user interaction unit 12 may be configured such that the catheter 11 is rotated within the mechanical fixture by using at least one of the further motors.
  • mechanical configurations of known robotic systems can be used for modifying the shape of the catheter 11 and moving the catheter 11 like the mechanical configuration of the Magellan robotic system from the company Hansen.
  • the user interaction unit 12 may be used by the physician via an input unit 17 comprising a keyboard, a computer mouse, a touchpad, a joystick and/or another input means for allowing the user to input desired navigation commands into the user interaction unit 12.
  • an input unit 17 comprising a keyboard, a computer mouse, a touchpad, a joystick and/or another input means for allowing the user to input desired navigation commands into the user interaction unit 12.
  • the shape of the catheter may be modified and the catheter may be moved in another way by using, for instance, magnetic means.
  • the catheter may be directly manually steered by using guidewires.
  • the interventional system further comprises a position and shape determining unit 13 for determining the position and shape of the catheter 11 within the person 9.
  • the position and shape determining unit 13 is adapted to use optical shape sensing for determining the position and shape of the catheter 11.
  • the position and shape determining unit 13 can be adapted to use the technique disclosed in US 7,772,541 B2, the technique disclosed in EP 2 478 331 A2 or another optical shape sensing technique for determining the position and shape of the catheter 11.
  • small embospheres which are particles designed to block blood vessels and which are coated with chemotherapeutic drugs, are injected directly into an artery supplying a tumor 10 via the catheter 11 by using a treating unit 19.
  • the treating unit 19 comprises a reservoir of the embospheres and a pump for transferring the embospheres via the catheter 11 to the hepatic artery.
  • the treating unit can also be adapted to inject another kind of particles like small spheres, which do not comprise a chemotherapeutic drug and which are just used for clogging desired vessels, or like small spheres with a radiation source like Y90 for performing a selective internal radiation therapy (SIRT).
  • SIRT selective internal radiation therapy
  • the injected embospheres restrict the tumor's arterial blood supply and the chemotherapeutic agent is delivered directly to the target tissue, thereby locally concentrating the chemotherapeutic agent in the area of the tumor, which leads to decreased
  • the TACE i.e. the injection of the embospheres
  • the TACE is performed in several interventional sessions, wherein between these several interventional sessions the catheter 11 may be completely removed from the person 9.
  • the same catheter 11 or different catheters may be used for different interventional sessions, which may also be regarded as being different interventional procedures.
  • the position and shape determining unit 13 is adapted to determine and store a first position and shape of the catheter 11 within the person 9 during the first interventional session and to determine a second position and shape of the catheter 11 within the person 9 during the second interventional session.
  • the first position and shape determined during the first interventional session is stored such that it can be shown on a display 18 during the second interventional session together with the actually determined second position and shape of the catheter 11 , in order to allow the user to navigate the catheter 11 during the second interventional session along the same path as used during the first interventional session, i.e. along the path indicated by the stored first position and shape of the catheter 11 determined during the first interventional procedure.
  • the second position and shape can be determined continuously during the second interventional procedure, while the catheter 11 is moved to the hepatic artery, while the respective actual second position and shape of the catheter 11 can be shown on the display 18 together with the stored first position and shape determined during the first interventional procedure, in order to allow the user to navigate the catheter 11 during the second interventional procedure along the path within the person 9 used during the first interventional procedure.
  • the position and shape determining unit 13 is adapted to register the actual second position and shape during the second interventional session with a corresponding part of the stored first position and shape.
  • the actual second position and shape defines a path having a certain length
  • this actual second position and shape can be registered with a corresponding part of the stored first position and shape defining a path having the same length. If during the second session the catheter has reached the target region, the corresponding entire second position and shape may be registered with the entire stored first position and shape.
  • the position and shape determining unit 13 is adapted to register the determined and stored first position and shape to the determined second position and shape by using known registration algorithms like known 3D-3D registration algorithms.
  • the position and shape determining unit 13 may also be adapted to allow a user to manually register the first and second positions and shapes and/or to perform the registration based on well-defined points used by both paths defined by the first and second positions and shapes like the skin entry point. Also a combination of these registration techniques may be used.
  • the position and shape determining unit 13 can be adapted to use a similarity measure for registering the first and second positions and shapes to each other, wherein the registration algorithm can be adapted to register the first and second positions and shapes to each other such that the similarity measure is maximized. If the maximized similarity measure is smaller than a predefined threshold, it may be assumed that the first and second positions and shapes define different paths within the person, which is preferentially indicated on the display 18.
  • the similarity measure can be based, for instance, on the Euclidean distance, a correlation, et cetera.
  • the interventional system 1 further comprises an imaging device 2 for generating an image of the person 9 during the intervention, wherein the display 18 is adapted to show an overlay image showing the first position and shape and the second position and shape overlaid on the image generated by the imaging device 2.
  • the imaging device 2 is a C-arm x-ray system for generating an x-ray projection image.
  • the C-arm x-ray system 2 comprises a C-arm 5, wherein at opposing ends of the C- arm 5 an x-ray source 3 and an x-ray detector 6, respectively, are mounted.
  • the x-ray source 3 is adapted to emit x-rays 4 traversing the person 9 and the x-ray detector 6 is adapted to detect the x-rays 4 after having traversed the person 9.
  • the C-arm is movable, in particular, rotatable and translatable, in order to generate x-ray projection images in different projection directions.
  • the C-arm x-ray system 2 further comprises a control unit 7 for controlling the C- arm x-ray system, in particular, for controlling the x-ray source 3 and the x-ray detector 6.
  • the control unit 7 is also adapted to generate the x-ray projection images based on detection values, which are indicative of the x-ray intensities detected by the x-ray detector 6 and which are received from the x-ray detector 6.
  • the interventional system 1 further comprises a user interface allowing a user to indicate when the first position and shape should be stored, wherein the position and shape determining unit 13 is adapted to store the first position and shape, when the user has indicated that the first position and shape should be stored.
  • the user interface is the input unit 17, which allows the user to input into the interventional system that the actual first position and shape of the catheter 11 should be stored.
  • the position and shape determining unit 13 can be adapted to continuously determine the first position and shape during the first interventional session, wherein the continuously determined first position and shape can be stored only, if this has been indicated by the user by using the user interface 17.
  • the first position and shape is stored, when the catheter 11 has reached the target region being, in this embodiment, the hepatic artery, in order to store the entire path used during the first interventional session.
  • Storing the first position and shape of the catheter 11 during the first interventional session, when the catheter 11 has reached the target region, allows navigating the catheter 11 during the second interventional session along the entire path used during the first interventional session.
  • the system can be adapted to allow the user to mark certain regions on the stored first position and shape during the first interventional session or after the first session has been completed by using a user interface 15. For instance, the user can indicate via the user interface 15 regions of the stored first position and shape of the catheter 11 , which should be marked.
  • These regions may comprise critical locations within the person 9 like vascular branch points.
  • the system can be adapted to allow the user to mark these regions, after the catheter 11 has reached the target region and after the first position and shape of the catheter 11 has been stored, directly on this stored first position and shape shown on the display 18, or the system may be adapted to allow the user to indicate the respective region, when the tip of the catheter 11 has reached the respective region during the first interventional session, wherein this indicated respective region can finally be marked on the stored first position and shape.
  • the marked regions can be shown on the display 18.
  • further first positions and shapes can be stored, before the catheter 11 has reached the target region. For instance, the user can indicate via the user interface 15 that a first position and shape of the catheter 11 should be stored, when the catheter 11 has reached a critical location within the person 9 like a vascular branch point.
  • the position and shape determining unit 13 can also be adapted to automatically store the first position and shape, when the catheter 11 has reached the target region during the first interventional session.
  • the position of the target region can be automatically determined based on a pre-acquired image of the person 9 like a computed tomography image or a magnetic resonance image or a user can mark the target region on such an image, wherein based on the position of the target region and the continuously determined first position and shape during the first interventional session it can be determined, when the catheter 11 has reached the target region, wherein then the first position and shape of the catheter 11 can be stored.
  • the user interface 15 may further be adapted to allow the user to indicate a part of the stored first position and shape, which should be shown on the display 18 alone, i.e. without the remaining part of the stored first position and shape, or which should be shown in a highlighted way with respect to the remaining part of the stored first position and shape, in order to allow the user to navigate the catheter 11 during the second interventional session based on the indicated part of the stored first position and shape and the actual second position and shape by using the user interaction unit 12.
  • the display 18 may display the entire stored first position and shape, wherein the user
  • the interface 15 may be a graphical user interface allowing the user to mark on the displayed stored entire first position and shape the part of the first position and shape, which should be used during the second interventional session.
  • the input unit 17 may be used together with the graphical user interface 15 for indicating the part of the stored first position and shape.
  • the user may mark the point on the original path, i.e. on the stored entire first position and shape of the catheter 11, up to the point where the user wants to follow the original path.
  • the stored entire first position and shape may be marked starting from the aorta, i.e. the original path from the catheter 11 may be reused only starting from the aorta.
  • the interventional system 1 further comprises an inner structure providing unit 16 for providing an inner structure of the person 9, wherein the display 18 may be adapted to display the provided inner structure together with the first and second positions and shapes of the catheter 11. This is schematically and exemplarily illustrated in Fig. 2.
  • the inner structure 20 schematically and exemplarily shown in Fig. 2 includes vessels 22, the liver 21 and the tumor 10.
  • the display 18 further shows the stored first position and shape 25, i.e. the original path used during the first interventional session, partly overlaid by the second position and shape 23, 24 of the catheter 11, which indicates the current position and shape of the catheter 11 during the navigation of the catheter 11 to the target region in the second interventional session.
  • reference number 24 indicates the position and shape of the tip of the catheter 11
  • reference number 23 indicates the position and shape of the remaining part of the catheter 11 during the second interventional session.
  • the interventional system can be adapted to show the entire inner structure 20 as illustrated in Fig. 2 or only a part of the inner structure 20 from the entry location of the catheter 11 , at which the catheter 11 has entered the person 9 in the second interventional session, to a current location of the tip of the catheter 11 as indicated by the actual second position and shape of the catheter 11.
  • the inner structure provided by the inner structure providing unit 16 may be a roadmap showing the vascular structure within the person 9, which indicates possible paths within the person 9, wherein the entire road map may be shown on the display 18 or only a part of the roadmap from the entry location of the catheter 11 , at which the catheter 11 has entered the person 9 in the second interventional session, to the current location of the tip of the catheter 11 as indicated by the actual second position and shape of the catheter 11 in the second interventional session may be shown on the display 18.
  • the user interaction unit 12, the user interface 15, the input unit 17 and display 18 are used for navigating the catheter 11 during the second interventional session based on the stored first position and shape and based on the second position and shape
  • these components can be regarded as being components of a navigation device for navigating the catheter 11 during the second interventional session based on the stored first position and shape and based on the second position and shape.
  • this navigation device is used together with the position and shape determining unit 13 for navigating the catheter 11 to the target region 10 within the person 9
  • the navigation device and the position and shape determining unit 13 can be regarded as being components of a navigation system for navigating the catheter 11 to the target region 10 within the person 9, which is integrated with the interventional system 1.
  • step 101 in a first interventional session the catheter 11 is navigated to a part of the hepatic artery, which provides the tumor 10 with blood, wherein the position and shape of the catheter 11 is determined by optical shape sensing during this navigation.
  • the determined position and shape of the catheter 11 is stored as the first position and shape to be used during a subsequent second interventional session.
  • step 102 embospheres are placed at the target region in the hepatic artery by using the treating unit 19 and the catheter 11. After the embospheres have been placed in the hepatic artery, the catheter 11 is removed from the person 9 in step 103 and the first interventional session ends.
  • step 104 during a second interventional session the catheter 11 is navigated to the hepatic artery, while the position and shape of the catheter 11 is continuously determined as a second position and shape and shown on the display 18 together with the stored first position and shape.
  • the respective actual second position and shape and the stored first position and shape may be shown overlaid on an x-ray projection image provided by the C-arm x-ray system 2 and/or on a representation of an inner structure 20 like a roadmap.
  • the user can navigate the catheter 11 during the second interventional session along the original path used during the first interventional session by using the user interaction unit 12.
  • Interventional sessions i.e. a third interventional session, a fourth interventional session, et cetera, can follow, wherein during the respective further interventional sessions
  • a stored position and shape of the catheter 11 determined during a previous interventional session is used for navigating the catheter 11.
  • the position and shape of the catheter 11 determined and stored during the first interventional session is used as the original path.
  • the interventional device is a catheter
  • the interventional device can also be another device like a guidewire, wherein also in this case the position and shape determining unit is adapted to determine and store a first position and shape of the interventional device within the living being during a first interventional procedure and to determine a second position and shape of the interventional device within the living being during a subsequent second interventional procedure, wherein a navigation device is provided for navigating the interventional device during the second interventional procedure based on the stored first position and shape and based on the second position and shape.
  • the intervention can be another intervention performed in different interventional sessions, i.e. having different interventional procedures.
  • the intervention can be any intervention, in which it is important that a path used during a first interventional session is also at least partly used during a subsequent second interventional session.
  • the intervention can be an ablation intervention, wherein in different ablation sessions at least partly the same path should be used, or it can be an injection intervention, wherein an injection device should be navigated along the same path in different injection sessions.
  • the intervention can also be another embolization intervention like a uterine- fibroids embolization intervention or a prostate embolization intervention.
  • diagnosing and treating pulmonary cancer can be performed in several sessions, wherein a flexible bronchoscope may be used for diagnosing and treating pulmonary tumors and wherein during the different sessions the bronchoscope should be navigated along the same path.
  • the intervention can also be a placement of a stent, like in Endo Vascular Aortic Repair (EVAR) or Fenestrated Endovascular Aortic Repair (FEVAR), in which the interventional device should be navigated along the same path in the different sessions of the intervention.
  • EVAR Endo Vascular Aortic Repair
  • FEVAR Fenestrated Endovascular Aortic Repair
  • the three-dimensional tracking during the first interventional session i.e. the determination of the first position and shape during the first interventional session, provides the information, which can be used to replicate intervention guidance in the same person in a follow-up interventional procedure.
  • TACE intervention the catheter is positioned in a part of the hepatic artery providing the tumor with blood. From there the chemoembolization material is injected. This procedure is repeated several times during different interventional sessions. Guiding the user, who is supposed to be an interventional radiologist, along the same device path to the same vascular position during the different interventional sessions can improve the quality and speed of these interventions.
  • the interventional system described above with reference to Fig. 1 can be adapted to track the complete catheter shape and its position throughout the first catheter intervention, i.e. throughout the first interventional session. Then, the point in time may be marked and thereby the three-dimensional position and shape of the catheter may be stored, when the catheter has reached its target location, in particular, when the chemoembolization material is injected in the artery. The stored position and shape of the catheter can then be regarded as being the target position and shape, which should be achieved again in the second interventional session.
  • the stored position and shape of the catheter i.e. the first position and shape of the catheter, can be regarded as being a person specific catheter position and shape for this type of intervention for this person.
  • Additional position and shape "snap shots" can be stored for later use at critical locations during the first interventional session, for instance, when the catheter tip reaches a vascular branch point.
  • the position and shape defining the entire path to the target region and the optional further “snap shots” may be stored in a database, wherein during each following intervention the stored catheter positions and shapes can be loaded from the database and can be compared with the actual position and shape of the catheter during progression towards the target region.
  • the one or several stored positions and shapes and the actual position and shape of the catheter can be displayed as a live overlay on x-ray projection images or they can be displayed directly, i.e. not being overlaid on an x- ray projection image. By comparing the different positions and shapes guidance can be given to the user how to move the catheter to match the recorded three-dimensional path most optimally.
  • the interventional system may also be adapted to partially reuse the original path, i.e. only a part of the stored first position and shape of the catheter determined during the first interventional session may be used for navigating the catheter during the second interventional session.
  • the catheter may be inserted at a comparable point in an artery in the patients groin while targeting a different vascular end point.
  • the user may mark the point on the original catheter path, i.e. on the stored first position and shape, up to the point where the user wants to follow it.
  • the catheter path i.e. the stored first position and shape, may be reused, once the aorta is reached in the second interventional session.
  • the stored first position and shape, which has been determined during the first interventional session is displayed together with an actual second position and shape of the catheter during the second interventional session, in order to allow the user to move the catheter during the second interventional session along the path, along which the catheter has also been moved during the first interventional session
  • the stored first position and shape of the catheter and the actual second position and shape of the catheter can also be used to automatically navigate the catheter to the target region along the path, which has been used during the first interventional session.
  • the catheter 11 may be a catheter being automatically controllable by a catheter control unit depending on a comparison between the stored first position and shape and the actual second position and shape.
  • the interventional system 1 may comprise the catheter control unit for automatically navigating the catheter during the second interventional session based on a comparison between the stored first position and shape of the catheter and the actual second position and shape.
  • the first and second positions and shapes are three-dimensionally registered to each other, the first and second positions and shapes may also be four-dimensionally registered to each other.
  • the first position and shape can be determined and stored together with a respective phase of a periodic movement of the person like a cardiac phase or a respiratory phase, wherein during the determination of the second position and shape also the cardiac phase or the respiratory phase can be determined and the second position and shape, which corresponds to the same phase as the phase stored with the first position and shape, can be registered with the stored first position and shape.
  • a single unit or device may fulfill the functions of several items recited in the claims.
  • the mere fact that certain measures are recited in mutually different dependent claims does not indicate that a combination of these measures cannot be used to advantage.
  • a computer program may be stored/distributed on a suitable medium, such as an optical storage medium or a solid-state medium, supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems.
  • a suitable medium such as an optical storage medium or a solid-state medium, supplied together with or as part of other hardware, but may also be distributed in other forms, such as via the Internet or other wired or wireless telecommunication systems.
  • the invention relates to a navigation system for navigating an interventional device like a catheter and an interventional system comprising the navigation system.
  • a position and shape determining unit determines and stores a first position and shape of the interventional device within a living being during a first interventional procedure like a first chemoembolization session and determines a second position and shape of an interventional device within the living being during a subsequent second interventional procedure like a second chemoembolization session.
  • the interventional device is navigated based on the stored first position and shape and based on the second position and shape. This allows considering during the second interventional procedure the path of the interventional device used during the first interventional procedure. In particular, this allows navigating the interventional device along the same path during the first and second interventional procedures.

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Abstract

L'invention concerne un système de navigation pour faire naviguer un dispositif d'intervention (11) tel qu'un cathéter, et un système d'intervention comprenant le système de navigation. Une unité de détermination de position et de forme (13) détermine et stocke une première position et une première forme du dispositif d'intervention dans un être vivant (9) pendant une première procédure d'intervention telle qu'une première session de chimio-embolisation, et détermine une seconde position et une seconde forme d'un dispositif d'intervention dans l'être vivant pendant une seconde procédure d'intervention ultérieure telle qu'une seconde session de chimio-embolisation. Pendant la seconde procédure d'intervention, le dispositif d'intervention navigue sur la base des premières position et forme stockées, et sur la base des secondes position et forme. Cela permet d'étudier, pendant la seconde procédure d'intervention, le passage du dispositif d'intervention utilisé pendant la première procédure d'intervention. En particulier, cela permet de faire naviguer le dispositif d'intervention le long du même passage pendant les première et seconde procédures d'intervention.
PCT/EP2014/068219 2013-09-06 2014-08-28 Système de navigation Ceased WO2015032676A1 (fr)

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JP2016539475A JP6480938B2 (ja) 2013-09-06 2014-08-28 ナビゲーションシステム
EP14755831.6A EP3041409A1 (fr) 2013-09-06 2014-08-28 Système de navigation
US14/914,016 US11395702B2 (en) 2013-09-06 2014-08-28 Navigation system
CN201480048813.6A CN105517489B (zh) 2013-09-06 2014-08-28 导航系统

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US11395702B2 (en) 2022-07-26
US20160206381A1 (en) 2016-07-21
CN105517489A (zh) 2016-04-20
JP2016532513A (ja) 2016-10-20

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